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ObamaCare 2016: The Stupid Awakens

This is an average American after being on hold with an insurance company for 20 minutes. Any questions?

Open enrollment season, a.k.a. “ObamaCare 2016”, has begun, and you better get on the ball and sign up for your government mandated health plans, lest you become the prey of the feared bureaucratic death squad. Don’t believe it? Try getting treatment for a joint condition and chances are, you could end up in hospice care.

I base this allegation on the recent experience of a friend, whose name I shall conceal using the high-tech, sophisticated of simply not telling you. This friend experienced the joys of insurance company bliss and government-mandated changes via the Affordable Health and Patient Confusion Act (AFLAC). She (Dammit! Wasn’t supposed to give out the gender) called the insurer after her physical therapy treatments for her knee, for no reason any human with the intellect of Styrofoam could understand, were not being authorized. After researching for several minutes, the representative at the insurance company realized what had happened. It seems my friend, who is the picture of health if you remove her knee, was actually slated to go into hospice care. This is no joking matter, folks! Hospice care is meant for people who are dying or, at the very least, terminally ill. Granted, my friend felt like she was going to die from laughter shortly after hearing this information, which could have actually validated the coding!

While this is scary enough, the fact that our system is designed to take coding as gospel, with little room for human neurons to intervene even to wave their hands as if to say “shit, the system really screwed the pooch this time!”. What if she wasn’t coded for hospice, but for something truly bizarre, such as a butt lift, or even, her being female, a male enhancement implant? The fact that this sort of error could happen may lead to a seriously entertaining conversation…

REPRESENTATIVE: We researched your file and discovered that you are, indeed, coded correctly. You are supposed to have a procedure called a “Symphysiotomy.”

INSURED: Sir, do you have any idea what on earth you told me I’ve been authorized and coded for?

REPRESENTATIVE: Please hold while I research that.

(twenty minutes of music featuring the top 1000 elevator music hits of all time, in reverse order).

REPRESENTATIVE: Thank you for holding the line, sir. You are, indeed, authorized for “Symphysiotomy.”

INSURED: I ask again. Do you know what that is?

REPRESENTATIVE: I have been advised, sir, that this is a common procedure used for childbirth when caesarean section is contraindicated.

INSURED: Very good. Now, may I ask you another question?

REPRESENTATIVE: Of course, sir.

INSURED: Why the hell are you authorizing a male to be sawed open and spread for childbirth, who is not only an Obstetrician, but also just needs to have a pre-cancerous mole removed?

(thirty minutes of elevator hold music, this time with a voice saying “We appreciate your business and patience while on hold. Please, hold the line, and we will be back with you soon.” – not shown, insured man screaming while biting into a clenched fist.)

REPRESENTATIVE: Sir, the coding is, indeed, correct. You are authorized for this procedure. I apologize for any inconvenience.

INSURED: You’re an idiot. *click*

Yes, folks, this is the sort of insurance nightmare we are now facing. It is far greater than anything we could possibly imagine, and even more stunning than the notion that Star Wars fans will not be allowed to use lightsabers or face masks in local theaters. Of course, it is a foregone conclusion that, had Anakin Skywalker been subject to the same sort of advance medical science as our society, his helmet would have likely be rejected due to coding issues and he would have, instead, had his mind and body transplanted in to the body of my friend’s dog. That, however, would have at least been entertaining to watch a dog force choke the mailman!

3 thoughts on “ObamaCare 2016: The Stupid Awakens”

Wish it were just limited to insurance companies but, alas, this same aggregiously low level of customer service exists across all U.S. industries: insurance, telecommunications, airlines, banking, the list goes on and on. I’m In awe of the fact that your friend at least got to speak to a live person.

This was indeed an amusing read, even if the problem is misidentified.

The entire US health care system CHANGED its CODES recently, going from ICD-9 to ICD-10, with over 400,000 changes going into immediate effect for EVERY insurer, affecting all injuries and diseases and every treatment option. This has been in the pipeline for more than a decade, and it would have happened whether Obamacare existed or not.

I’m just a lowly imaging tech, but it’s been a damned nightmare for us at our small-town urgent care. People at the local 35-bed hospital are quitting over it! That many code changes happening all at once is crashing and glitching the billing software and servers of many, many health care facilities. We’ve had to temporarily revert back to paper-based charts several times.